Parent Management Training – Oregon Model (PMTO™)

An Evidence-Based Practice Developed in Our Community

Presented at ORI’s 8th Annual Research to Practice Conference, Supporting Families Through Evidence-Based Approaches: Meeting Diverse Levels of Need, Eugene, OR (December 3, 2010).

Mark EddyLaura Rains

Focus For Today

1. How This All Came About2. Implementation History3. Active Teaching4. Summary5. Conversation

Eugene-Springfield Non-Profits

Oregon Social Learning Center

Implementation Sciences International, Inc.

A Typical Case

• 8 year old • Having trouble at home• Having trouble at school • Parent feels has tried everything• Don’t know what to do

Eugene-Springfield, 1950s

• Child Guidance Clinic• Child Study Center• Play therapy

– Child focused– Wasn’t working for typical case– Needed new model

Jerry Patterson, 1960s

• When things aren’t working, go back to the drawing board

• Basic research– Conclusion that problem not just inside the

child, but that what is going on around the child matters

– What parents, teachers, and other adults do can change what a child does

Developing an Evidence-Base

• 1950s: Basic laboratory research• 1960s: Outpatient clinical research• 1970s: Longitudinal studies• 1980s: Juvenile justice, child welfare, and

mental health systems• 1990s: School system, community-based non-

profits:• 2000s: Criminal justice system; early childhood

intervention; communities, states, countries

Treatment /Control

Parenting Practices

Child Outcomes

Divorced Mothers (PTC)

Adjudicated Youth

Step-families (MAPS)

School in High Crime Neighborhoods (LIFT)

Treatment Foster Care: Delinquents - Boys

SAMPLES

Foster Care: Mentally Ill (Hospitalized)

Maltreated Children

Treatment Foster Care: Delinquents - Girls

Early Intervention Treatment Care (2-4)

Arrest Rates / Severity of Crime

Substance Use

Noncompliance

Delinquent Behaviors

Academic Function

CHILD OUTCOMES

Out of Home Placement

Deviant Peer Associations

Depression

PARENT OUTCOMES

Depression

Standard of living

Arrest rates

Marital satisfaction

Marital adjustment

POSITIVE PARENTING PRACTICES

Skills Encouragement

Positive Involvement

Effective Discipline

Problem-solving

Monitoring / Supervision

Negative Reinforcement

Escalation

Negative Reciprocity

NEGATIVE PARENTING PRACTICES

Forgatch & Patterson, 2010

Forgatch & Knutson, 2002

Lifecourse Perspective

Parent Management Training

• Empowering parents with core strategies:– Skill Encouragement– Limit Setting– Monitoring/supervision– Family Problem Solving– Positive Involvement

• Considered one of two “well established” treatments for conduct disorder (American Psychological Association)

Family-Based Programs on 3 or More Federal Best Practice Lists

Classification Percent Cumulative Percent

Developed at OSLC 23%

Derived from OSLC 23% 56%

Includes many OSLC elements

33% 81%

Few or no OSLC elements

19%

Primary Target: Parent Behavior• Spending positive, quality time with children • Encouraging participation in normative

behaviors/activities, teaching in small steps• Providing consistent, mild, small, nonviolent

consequences for problem behaviors• Monitoring of daily activities in and outside

home, supervising who, what, where, when• Goal setting, interpersonal planning,

negotiating, trying out agreements• Separating child from delinquent peers,

encouraging relationships with prosocial peers

Key Intervention Targets

• The presence and behavior of adults in parental roles

• The presence and behavior of peers

Social Interaction Learning Model

Child AdjustmentPositive Involvem

ent

Skill E

ncou

rage

men

t

Mon

itorin

gP

roblem solving

Lim

it S

ettin

g

Aversive Behavior

Negative R

eciprocity Escal

atio

nNeg

ative

Rei

nfor

cem

ent

Coercive

Positive

Disrupted parentingAdverse Contexts Child AdjustmentPositive Involvem

ent

Skill E

ncou

rage

men

t

Mon

itorin

gP

roblem solving

Lim

it S

ettin

g

Aversive Behavior

Negative R

eciprocity Escal

atio

nNeg

ative

Rei

nfor

cem

ent

Coercive

Positive

Disrupted parentingAdverse Contexts

Forgatch & Patterson, 2010

23,020912

Norway

29

Forgatch, 2010

680290

Iceland

2

Forgatch, 2010

108163

The Netherlands

26

Forgatch, 2010

1056157

Michigan

24

Forgatch, 2010

Denmark

24

48

4

Forgatch, 2010

Role Play as a PMTO Teaching Tool

• Teaching is active!• Learning is kinesthetic• Engages family in the change process• Decreases time spent in “talk”• Parents practice skill before using at home

with children

Active Teaching: The 3-D Approach

• Demonstrate: Model appropriate and sufficient information. Engage family quickly and effectively with RP. Be theatrical.

• Differentiate: Help parents specify characteristics that differentiate effective and less effective action.

• Debrief: Punctuate and frame effective actions. Guide parents to recognize and reinforce their own and each other’s successes.

PMTO Role Play: 3-Step DanceRP Setup• Models/demonstrates • Draws family in quickly and effectively • Provides direction (who is to do exactly what)

RP Practice• Guides (exactly how)• Uses theatrical strategies• Breaks role play into small steps

RP Debrief• Punctuates, reinforces, supports, encourages • Weaves in instructional material• Differentiates effective and less effective action

Spotlight: Wrong Way / Right Way RP

• Wrong way demonstration normalizes the parenting experience, increases session comfort and introduces humor into the situation

• Dramatic wrong way RP ushers in surprise and insight

• Wrong way/right way RPs are used to compare and contrast

• Emphasis is spent on practicing the right way

Let’s

try

it

out!

Let’s try it out!Role Play #1: Practice as parent

Practice 2 wrong way, 2 right way directionsRoles: Parent, Child

“Put your shoes in the closet now, please.”•“Use an inside voice now, please.”•“Put your toys away in the toy box now, please.”•(Name), do (________) now, please.”

Let’s try it out!Role Play #2: Practice as therapist

Practice demonstrating “wrong way/right way” directions and debriefing role plays

Roles: Therapist, Parent

1. Model wrong way directions2. Debrief3. Engage parent in building better direction4. Model right way direction5. Debrief

PMTO at a Glance

1.Core belief: Parents are their children’s best teachers

2.Strength-based: Strengthening skills via coaching

3. Implementation strategy: Teach therapists to teach parents to teach children

4.Teaching: Engaging, active, fun!

5.Based on 40 years of research and practice*

* Forgatch, M.S., & Patterson, G.R. (2010)

Shine the light on what you want to grow!

Sigmarsdóttir, Rains, Knutson, & Forgatch, 2009

Fidelity of Implementation Rating System (FIMP)

• Rating system that evaluates competent adherence to PMTO.

• Based on direct observation of therapy.

• Video recordings uploaded to portal.

• Used to certify PMTO therapists, coaches, group leaders

Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009

Knowledge: Proficiency in understanding theoretical model, core and supporting principles and practices, details and proceduresStructure: Session management, leads without dominating, responsive, sensitive pacing/timing Teaching: Promotes mastery, elicits goal behavior, teaching is active (e.g., role play) and engagingProcess: Proficient clinical & strategic skills, safe learning context Overall: Promotes growth, satisfaction, likely return, adjusts for context, difficulty Sessions scored: Encouragement and Limit Setting (intro & troubleshooting)

Fidelity of Implementation Rating System (FIMP): The manual for PMTO™

(Revised: Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009)

9-Point Likert Scale Good work = 7-9; Acceptable = 4-6; Needs Work = 1-3

● Teaching tool for coaching

● Evaluation of Training & Certification

● Evaluation of Drift across generations

● Evaluation of drift within a generation

● Evaluation of theoretical mechanisms: Does PMTO Fidelity result in improved parenting?

Uses of FIMP

Fidelity To Intervention Model

FidelityChange

Parenting

ChangeChild

Behavior

PARENT

Divorce

Neighbor-hood

Unemploy-ment

Stress

Poverty

SubstanceUse

DeviantPeers

Conflict

LowEducation

Psycho-pathology

Culture

The Parking Lot

The Parking Lot